You are here

Article Text

Article menu

Download PDFPDF

XML
Original research
Drivers of antibiotic use in Vietnam: implications for designing community interventions
  1. Shannon McKinn1,
  2. Duy Hoang Trinh2,
  3. Dorothy Drabarek1,
  4. Thao Thu Trieu2,
  5. Phuong Thi Lan Nguyen3,
  6. Thai Hung Cao4,
  7. Anh Duc Dang3,
  8. Thu Anh Nguyen1,2,
  9. Greg J Fox1,2,
  10. Sarah Bernays1,5
  1. 1Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
  3. 3National Insitute of Hygiene and Epidemiology, Ministry of Health, Hanoi, Vietnam
  4. 4Medical Service Administration, Ministry of Health, Hanoi, Vietnam
  5. 5Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Sarah Bernays; sarah.bernays{at}sydney.edu.au

Abstract

Introduction Antimicrobial resistance is a global challenge that threatens our ability to prevent and treat common infectious diseases. Vietnam is affected by high rates of antimicrobial resistant infections, driven by the overuse of antibiotics and the Vietnamese government has recognised antimicrobial resistance as a health security priority. This study aimed to understand how people in Vietnam use antibiotics in community settings, and the factors that impact their practices and decision-making regarding antibiotics.

Methods We conducted 43 qualitative in-depth interviews with 50 community members in two urban and two rural sites in Vietnam. We conducted iterative, inductive thematic analysis alongside data collection through a process of systematic debriefings based on detailed interview summaries. Through this process, we developed a coding framework that was then applied to transcribed interview data.

Results Frequent and indiscriminate use of antibiotics was driven by the powerful appeal that antibiotics held for many Vietnamese consumers. Consumers were discerning in making decisions in their purchase and use of antibiotics. Consumers’ decisions were affected by perceptions of what constitutes high-quality medicine (effective, strong, accessible and affordable); privileging symptom control over diagnosis; social constructions of antibiotics as a trusted remedy with embodied evidence of prior efficacy, which is reinforced by advice from trusted sources in their community; and varied, generally incomplete, understanding of the concept of antibiotic resistance and its implications for individuals and for public health.

Conclusion Antibiotic use at the community and primary care level in Vietnam is driven by community members’ social and economic response to what constitutes effective healthcare, rather than biomedical logic. Community-based interventions to reduce unnecessary antibiotic use need to engage with the entangled socio-structural factors that ‘resist’ current public health efforts to ration antibiotic use, alongside biomedical drivers. This study has informed the design of a community-based trial to reduce unnecessary antibiotic use.

  • qualitative study
  • health policy
  • public health
  • infections
  • diseases
  • disorders
  • injuries

Data availability statement

Data are available upon request. Data underlying our findings cannot be made public for ethical reasons, as they contain information that could compromise the privacy and consent of research participants. Data requests may be sent to the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2021-005875

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon request. Data underlying our findings cannot be made public for ethical reasons, as they contain information that could compromise the privacy and consent of research participants. Data requests may be sent to the corresponding author.

    View Full Text

    Footnotes

    • Handling editor Seye Abimbola

    • Contributors SM contributed to data analysis and interpretation, drafting and critically revising the manuscript. DTH, TTT and PTLN contributed to data collection, data analysis and interpretation, and critically revising the manuscript. DD contributed to study design, data analysis and interpretation, and critically revising the manuscript. TAN, TCH, ADD and GF contributed to study design, and critically revising the manuscript. SB contributed to study design, data analysis and interpretation, and critically revising the manuscript. All authors gave final approval of the submitted manuscript, and all authors are guarantors.

    • Funding Funding for this research was provided by the Australian Department of Foreign Affairs and Trade (NHMRC APP1153346), with support by the Indo-Pacific Centre for Health Security. GF was supported by a Career Development Fellowship (NHMRC APP1148372).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.